Pharmacology Flashcards
(93 cards)
1
Q
7 factors that influence prescribing decisions
A
indication/diagnosis recommended drug contraindications/special circumstances product licence patient expectations cost effectiveness follow up
2
Q
___ is an absolute contraindication to ACEIs
A
bilateral renal artery stenosis
3
Q
warfarin is/isnt contraind in preg
A
is
4
Q
COCP is contraindicated if there is a FH of __
A
thrombophilia
5
Q
___ should not be given with warfarin as increases risk of GI bleed
A
naproxen
6
Q
avoid trimethoprim in ___ of preg
A
1st trimester
7
Q
can / cant give ciprofloxacin in preg
A
cant
8
Q
can give nitrofuratoin for ___ in 1 st trimester
but avoid at term because causes ___
A
cystitis
haemolysis
9
Q
___ is the ACEI of choice in hepatic impairment as the others are ___
A
lisinopril
prodrugs
10
Q
anxiolytics and sedatives eg diazepam may cause ___ in hepatically impaired
A
coma
11
Q
t1/2 of amlodipine __ in patients with hepatic impairment so what do you do to their dosage?
A
increases
decrease dose
12
Q
___ isnt licensed for but is 1st line in treatment of migrain
A
amitryptyline
13
Q
2 drugs secreted into prox tubule by OAT
A
thiazides and loop diuretics
14
Q
2 drugs secreted into prox tubule by OCT
A
triamterene and amiloride
15
Q
___ is secreted into proximal tubule by OAT and so if use __/___ diuretics which also use OAT then its secretion is decreased
A
uric acid
thiazides/loops
16
Q
act at proximal tubule to inhibit HCO3- reabsorption = ___ eg.
A
carbonic anhydrase inhibitors
acetazolamide
17
Q
loop diuretics act on ____ in the ___
A
Na/K/2Cl cotransporter
thick ascending loop of Henle
18
Q
thiazides act on __ in the __
A
Na/Cl transporter
distal convoluted tubule
19
Q
loop diuretics cause reabsorption of +++ to be decreased
A
Na, K, Ca, Mg
20
Q
loop diuretics have an indirect ___ action acutely which is beneficial in ___
A
venodilator
pulmonary oedema
21
Q
loop diuretics are/arent effective in severe renal failure
A
are
22
Q
indications for loop diuretics
A
acute pulmonary oedema CKD ascites CCF nephrotic syndrome hyperCa2+/renal stones increase urine volume in AKI
23
Q
adverse affects of loops and thiazides usually occur within ___ if they are going to happen
A
2 wks
24
Q
complications of loop diuretics
A
hypoK metabolic alkalosis (H+ loss) hypovolaemia and lbp hypoCa2+ and Mg+ hyperglycaemia hyperuricaemia hearing loss - dose dependent
25
thiazides: increased __ load to collecting tubule => __ loss => ___ reabs increased in distal tubule
Na
K
Ca2+
26
thiazides have an indirect ___ action and so are useful in __
venodilator
| hbp
27
indications for thiazides
```
mild HF
hbp
severe resistant oedema (w a loop)
nephrolithiasis
nephrogenic DI
```
28
thiazides don't work if ___
eGFR <30ml/min
29
thiazide that can be used if GFR <30ml/min
| is used in combo with a loop for diuresis
metolazone
30
adverse affects of thiazides
```
postural hypotension
metabolic alkalosis
hypoK,Na and Mg
hyperCa2+
hyperglycaemia and lipidaemia
gout
```
31
loops or thiazides cause a greater K+ loss
thiazides
32
thiazides and loops, because they cause Na+ loss can cause activation of __ leading to further __ loss
RAAS
| K+ loss
33
amiloride and triamterene block ___
apical Na+ channel => Na reabs
34
spironolactone and eplerenone compete with __ for intracellular receptors => decreased gene expression and synth of protein that activates ___
also decreases no of ___
aldosterone
Na+ apical channels
NaKATPase on basolateral membrane
35
amiloride and triamterene enter nephron via ___ in prox tubule
more potent one =
better gut absorption =
OCT
amil
triam
36
spironolactone is rapidly metabolised in ___ to __ = 50-66.6% of the drugs action
liver
| canrenone
37
uses of K+ sparing diuretics
mod-severe CCF
2ndry hyperaldosteronism
Conns
resistant essential hbp
38
carbonic anhydrase is present in _+_+_+_+_+_
```
prox tubule
gastric mucosa
pancreas
eye
brain
RBC
```
39
adverse effects of acetazolamide
alkaline diuresis, hypoK
| metabolic acidosis
40
extrarenal uses of carbonic anhydrase inhibitors
glaucoma
acute mountain sickness
alkalinise urine (UTI/dysuria)
some infant epilepsies
41
osmotic diuretic =
mannitol
42
major site of action for osmotic diuretics eg mannitol =
prox tubule - where iso-osmotic reabs of H2O occurs
43
mannitol is given as a __
10-20% IV solution - there is no gut absorption
44
use of osmotic diuretics eg mannitol =
acute raised ICP and IOP and to prevent impending acute renal failure - maintains GFR and urine flow
45
adverse affect that is common with mannitol (osmotic diuretics)
hyponatraemic headache
46
ADH receptors:
V1a+b =
V2 =
vasoconstriction
| more sensitive, vasodilatory, AQP2 insertion in collecting duct
47
vasopressin analogues =
```
terlipressin
desmopressin (more potent and longer action)
```
48
neurogenic DI Rx =
desmopressin
49
causes of nephrogenic DI
| Rx =
recessive X-linked mutations in V2 ADH receptor gene / lithium / demeclocycline
thiazide (paradoxical effect)
50
Rx for bedwetting / enuresis in >10yo kids
PO/ intranasal desmopressin
51
aquaretics/vaptans effects =
increase serum Na
decrease urine osmolarity
electrolyte free aquaresis
52
aquaretics/vaptans indications for use =
excess AD:H to correct hypoNa - SIADH, CCF and cirrhosis
53
nonselective (V2 and 1a ADH receptor antagonist) aquaretics/vaptans =
conivaptan IV only
54
oral and V2 receptor selective vaptans
tolvaptan, lixivaptan, satavaptan
55
____ protects the myocardium from hyperkalaemia
calcium gluconate
56
```
most important prostaglandins in the kidney
function =
```
PGE2 + I2
vasodilatory of afferent arteriole - increase RBF and GFR
diuretic effect - h20 K+ and Na+ excretion
57
in volume depleted state need ___ to maintain GFR and RBF so can precipitate AKI if then give ___
PGs - I2+E2
| NSAIDS
58
uricosuric agents egs
probenecid
sulfinpyrazone
benzbromarone ( can be used in mild renal failure)
59
block the active transport of organic acids => reduced net absorption of urate =
uricosuric agents
60
uricosuric agents arent suitable in __/Hx of
renal impairment
| stones
61
___ antagonise uricosuric agents in the prox tubule
aspirin/salicylates
62
SGLT that reabsorbs 90% of glucose and where is it
2
| S1 of proximal tubule
63
minimum amount of haemodialysis per week
4hrs 3x/wk
64
restrictions on ptnts on dialysis
low salt and potassium diet
phosphate binders
1l fluid restrict
65
gold standard for vascular access in haemodialysis
AV fistula
66
how long does it take for a AV fistula to mature for haemodialysis
6wks
67
vascular access method for haemodialysis that can be used immediately
tunneled venous catheter
68
treat infection of a tunneled venous catheter for haemodialysis with
vancomycin
| remove/exchange
69
process for continuous peritoneal dialysis
4 days/day = 30 min per bag = 2hrs total
70
process for automated peritoneal dialysis
1 bag fluid overnight for 9-10hrs
71
why don't you correct urea levels too quickly when starting dialysis?
urea has built up in brain
| remove fast => seizures+cerebral oedema = disequilibrium syndrome
72
mechanism for hyperacute transplant rejection
+ve cross match = preformed Igs to transplant tissue
73
mechanism for acute transplant rejection
T/B cell mediated
| Rx = increase IS
74
mechanism for chronic transplant rejection
immunological and vascular deterioration
75
IS used for induction in transplant ptnts
steroids, MMF, CyA, tacrolimus, antibodies
76
calcineurin inhibitor egs
tacrolimus
| cyclosporin
77
immunoogical effect of calcineurin inhibitors
inhibit Th activation
78
SE of calcineurin inhibitors
renal dysfunction
hbp
diabetes
tremors
79
azathioprine should not be given with which drug
allopurinol
80
azathioprine and mycophenolate are ___ that block ___
antimetabolites
| purine synthesis
81
steroids affect which immunological cells
decrease T cell activity and B cell proliferation
82
absolute contraindications to transplanting kidney
```
malignancy - current or solid tumour in last 2-5yrs
untreated tb
severe IHD not amenable to Sx
severe airway disease
active vasculitis
severe PVD
```
83
transplant can have delayed function due to __
lasts __ so put on ___ in meantime
use ___ to detect rejection
ATN
10-30days
dialysis
biopsy
84
if dehydrated and don't stop ___ can cause AKI
ACEI
85
how to decide if need Rx for hyperkalaemia
ECG
86
1st ECG sign of hyperkalaemia
tall peaked T waves
87
drugs that can cause pre renal AKI
diuretics
| ACEI/ARB
88
drugs that can cause renal AKI
gentamicin
sulfonamides
aspirin
89
drugs that can cause post-renal AKI
methylsergide
| chemo
90
10 drugs with narrow therapeutic index
```
theophylline
warfarin
lithium
gentamicin
digoxin
vancomycin
phenytoin
cyclosporin
carbamazepine
levothyroxine
```
91
B adverse drug reactions are
bizarre - dose independent and unpredictable
92
drug-drug interactions of statins
fibrates
| macrolides
93
herbal remedies that affect anticoagulation medication
gingko biloba
saw palmetto
glucosamine
